ABSTRACT
Viral hepatitis is caused by hepatotrophic viruses with
Hepatitis B and Hepatitis C being the frequent viruses affecting humans.
Infections with HBV and HCV in pregnancy results in complications to the
neonate and mother. Determination of the infection in pregnant women as well as
the associated risk factors helps to identify neonates at risk of mother to
child transmission and hence appropriate measures taken to help prevent the
infection. A cross sectional study was carried out at the Catholic Hospital, Battor,
to investigate the seroprevalence of HBV and HCV virus infections and
associated risk factors among pregnant women attending the antenatal clinic.
Structured questionnaire were administered to obtain the socio demographic data
and Enzyme Linked Immunosorbent Assay, ELISA from Human diagnostic worldwide,
Germany) was used to investigate the presence HBsAg, anti-HBc and anti HCV. One
hundred and thirty five (135) pregnant women were enrolled in the study. HBsAg
was detected in 37 of these women, giving an overall prevalence of 27.4%. Among
these women 5 (13.5%) tested positive for HBeAg indicating that this proportion
of patients was highly infectious and therefore likely to transmit the virus to
their offspring. The prevalence of hepatitis C in the study population was 8.8%
and 60.7% tested positive for anti HBc. Parity, educational background and the
use of protection during sex were factors that did not have any statistically
significant association in the acquisition of these infection but the age of
the subjects had a significant association with the acquisition of both HBV and
HCV. Among the associated risk factors analyzed, having multiple sexual
partners was the only significant factor in the acquisition of HBV infection
whiles history of previous blood transfusion was associated to the acquisition
of HCV infection. The results from this study reveals a high prevalence of HBV
and HCV among pregnant women in the area.
CHAPTER ONE
INTRODUCTION
1.0 Background to the study
Hepatitis is inflammation of the
liver characterized by the existence of inflammatory cells in the tissue of the
organ principally caused by viral infections. There are five hepatotrophic
viruses Hepatitis A B C D and E that are recognized to cause hepatitis and of
these, Hepatitis B virus and Hepatitis C virus are amongst the most regular
viral infections in human beings (Eke et al., 2011; El-Serag, 2012). Hepatitis
can also be caused by toxins (some drugs, plants and alcohol), other infections
and certain autoimmune diseases (Ahmedin et al., 2004).The major public health
problem, particularly in developing countries among the liver diseases are the
one caused by hepatitis B and C (Haider et al., 1994; Santiago-Munoz et al.,
2005) and are extremely prevalent in the sub-Saharan Africa (Kwan et al., 1997;
Kramvis and Kew, 2007). Hepatitis is called acute when infection lasts for less
than six months and chronic when infection continues longer. Most infection
occur with limited or no symptoms, but often leads to vomiting, jaundice,
malaise, fatigue anorexia (low appetite) and abdominal pain. (Ryder and
Beckingham, 2001).
The mode of Hepatitis B virus
transmission is through infected blood, by sexual means and mother to child
(vertically) in the perinatal duration. Perinatal transmission is the principal
mode of hepatitis B virus (HBV) transmission globally (Tran, 2009). Most people
are infected by vertical transmission, or in the early-childhood in endemic
areas, (Wright, 2006). Without immunization of the pregnant women, up to 90% of
newborns born to mothers will become chronic carriers of the infection (McMahon
et al., 1985; Chang, 2000; Sandesh et al., 2005).
Parenteral routes such as
intravenous drug use or blood product transfusion, sexually and vertically
during delivery is mainly the mode in which hepatitis C is transmitted
(Dienstag, 1983; Melbye et al., 1990; Wejstål et al., 1992). Mother to child
transmission of hepatitis C virus occurs in 3%-10% of pregnancies complicated
by hepatitis C virus infections (Berkley et al., 2008). The World Health
Organization (WHO) approximated that 3.0% of the world's populaces are infected
with hepatitis C virus chronically where most of these cases are coming from
Africa which is reported to have the highest prevalence rate of hepatitis C
virus infection (Lavanchy, 1999; Madhava et al., 2002).
The prevalence of hepatitis B virus
amongst women who are pregnant globally is about 5.0% ranging from 0.6% in low
endemic regions to greater than 20.0% in high endemic areas in the Far East and
Africa whiles the occurrence of hepatitis C virus amongst women who are
pregnant globally is between 1.0% and 8.0% (Petrova and Kamburov, 2010; Arshad et
al., 2011). In Southern African countries, the occurrence of hepatitis B virus
among pregnant women is 2.0% to 2.9% except South Africa which has a prevalence
of 4.6% (Alter, 2007; Sinha and Kumar, 2010), whiles the prevalence of HCV in
these same countries is reported to be 0.1% (Njouom et al., 2011). In Central
Africa, the prevalence of hepatitis B virus among women who are pregnant ranges
from 6% to 9.5% whiles the prevalence of HCV is 4.3% (Ugbebor et al., 2011;
Kfutwah et al., 2012). HBV prevalence in Western Africa is high varying between
6.2% and 16% whereas the prevalence of HCV ranges from 2.2% to 3% (MacLean et
al., 2012; Okusanya et al., 2013).
Chronic infection with hepatitis B
virus and hepatitis C virus are frequently asymptomatic but there is a high
vertical transmission rate which can proceed to cirrhosis of the liver and
hepatocellular carcinoma. During pregnancy, infections with viral hepatitis are
related with high maternal risk, neonatal and foetal problems (Ali and Adam, 2011).
Foetal and neonatal hepatitis may lead to chronic virus carriage, which might
result to impaired physical and mental health in the future.
Chronic virus carriage is usually caused by neonatal hepatitis, which in turn
may lead to liver cirrhosis and hepatocellular carcinoma among young adults
(Sookoian, 2006; Wright, 2006; Shukla et al., 2011). In addition, inducement of
premature labor, poor outcomes of infants such as still births, neonatal deaths
(NND) and high maternal mortality have been reported to be caused by acute
hepatitis in pregnancy (Bohidar, 2004; Gambarin-Gelwan, 2007). The mother is
also at risk of postpartum hemorrhage and high incidence of hypertensive
disorders. If the pregnant woman has had acute hepatitis B infection during
late pregnancy perinatal transmission of this disease happens, in the first
post-partum or if the pregnant woman is a long-lasting HBsAg carrier (Levy and
Gagnadoux, 1996).
However, early diagnosis of
hepatitis B and hepatitis C infections in women who are pregnant can aid in
treatment and management of the disease much more efficiently. A preventive
measure includes immunization with hepatitis B virus (HBV) vaccine which is the
most effective mode of hepatitis B virus infection prevention. Hepatitis B
immune globulin (HBIG) also safeguards the infant by passive immunization if
given just before or soon after exposure to hepatitis B virus. In addition,
screening of pregnant women for HBV infection and routine screening of blood
donors for HBsAg, strict surveillance, good personal hygiene and proper
measures to control the environmental factors should be practiced to reduce
transmission.
Treatment regimen following a
positive diagnosis of the infection involves the use of interferon alpha 2b, P EG-interferon
alpha 2a, , lamivudine, adefovir, entecavir, telbivudine and tenofovir (Tran,
2009).
There is no vaccination for HCV
infections on the other hand but the infection can be prevented avoiding
contact with infected blood, avoid sharing of razor blades, toothbrushes, shavers and needles and avoidance
of alcohol intake (CDC, 1998a; Wiley et al., 1998). Treatment regimen is the
use of pegylated interferon (I FN) alpha and ribavirin (Fried et al., 2002;
Hadziyannis et al., 2004). Early detection of HCV infection ensures early
administration of antiviral treatment which is the most effective than
beginning at a later stage (Alter et al., 1990). Moreover, early identification
together with counselling and life style modification reduces the transmission
of the infection to other people. In Ghana, particularly in Battor which is a
rural area where the level of education is low and also the level of teenage
pregnancy being high, it is expected that some of the sexually transmitted
diseases like hepatitis B and hepatitis C will be prevalent among the youth.
Despite the inclusion of Hepatitis B in the routine antenatal care screening,
some newborns are still at risk of vertical transmission of the disease. The
study therefore, was to determine the prevalence of these viruses among healthy
pregnant women.
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